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Study Problem

The spread of germs from the hands of food workers to food is an important cause of foodborne illness outbreaks in restaurants. It accounts for 89% of outbreaks in which food was contaminated by food workers. Proper handwashing can reduce germs on workers’ hands and the spread of germs from hands to food and from food to other people.

The U.S. Food and Drug Administration (FDA) recommends handwashing before making food and putting on gloves to make food. FDA advises that hands be washed after

Eating,

Drinking,

Using tobacco,

Coughing,

Sneezing,

Using tissue,

Preparing raw animal products,

Handling dirty equipment, and

Touching the body (such as scratching your nose).

Handwashing may not always be enough to stop the spread of germs from hands to food. So the FDA recommends use of barriers such as gloves to stop the spread of germs. But research on handwashing and glove use in restaurants shows that these practices do not occur as often as they should. To improve these practices, we must understand factors linked with these practices. We interviewed and watched food workers to collect data on these practices.

Study Purpose

This study looked at how restaurant traits such as the number of meals served were linked with food workers’ handwashing and glove use practices.

Study Findings in Brief

EHS-Net found that food workers were more likely to wash their hands when they should

When they were not busy.

In restaurants with

food-safety training,

more than one hand sink, and

a hand sink where workers could see it.

Study Method

Participants

We collected data in 321 restaurants. These restaurants were located in the EHS-Net states and were selected at random. We interviewed a manager or worker in each restaurant. We also watched a food worker handling food.

Data Collection

State or local environmental health specialists collected the data. In each restaurant, they watched a food worker for about an hour and collected data on their handwashing and glove use.

The specialists looked for activities where FDA says handwashing should occur and then noted whether hands were washed. The specialists also interviewed a manager or worker about restaurant traits linked to hand hygiene behavior, such as worker food safety training and the restaurant’s physical and social environment.

Study Results

Handwashing was more likely to occur

Before food preparation than with other work activities.

When workers were not busy.

In restaurants where workers had food-safety training.

In restaurants with more than one hand sink.

In restaurants with a hand sink in view of the observed worker.

Glove use was more likely to occur

During food preparation than during other work activities.

When workers were not busy.

In chain restaurants.

In restaurants with glove supplies in areas where food was prepared.

Handwashing and glove use were linked to each other. Handwashing was less likely to occur when gloves were worn.

Several traits were not related to either handwashing or glove use. These factors were

Type of food preparation process.

Hand hygiene training.

Manager certification.

Hand washing supplies located at the hand sinks.

Worker visibility to manager.

Management encouragement of hand washing (as reported by manager).

Study Conclusions

Handwashing and glove use rates were highest before food preparation. This suggests that at least some workers may know that food needs to be protected from dirty hands.

Workers wearing gloves when handwashing should occur were less likely to wash their hands at that point than were workers who were not wearing gloves at that point. This suggests that glove use may lead to less handwashing.

Workers were more likely to wear gloves in chain restaurants. This suggests that glove use may be partially determined by restaurant managers.

EHS-Net Recommends

Restaurant management and food safety programs should

Review restaurants’ practices and surroundings in light of the findings of this study and highlight potential barriers to and supporters of hand hygiene.

Know that efforts to improve hand hygiene in restaurants should address the factors that affect hand hygiene behavior.

Revise food-preparation activities to lower the number of needed handwashings. For example, a sandwich-making process could be revised to lower the number of times a worker has to handle raw meat. This would lower the number of handwashings needed and should increase the odds that workers will wash their hands as needed.

Researchers should conduct more research on factors that affect hand hygiene and on the link between glove use and handwashing.